Date of Award

9-28-2009

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Lei Chen, MD

Abstract

OPTIMAL NEEDLE ANGLE FOR LUMBAR PUNCTURE IN CHILDREN AS DETERMINED BY ULTRASONOGRAPHY. Rebecca E. Bruccoleri and Lei Chen. Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University, School of Medicine, New Haven, CT. The objective was to find the optimal angle to perform lumbar punctures in children ages 0 to 12 years. We hypothesized that there is a consistent angle in different stages of development. Children ages 0-12 years who presented to the Yale-New Haven Childrens Hospital at a low acuity level or in need of a lumbar puncture and their siblings were eligible for the study. A lumbar puncture was not required as part of the treatment plan for participation in the study. The goal enrollment was 10-20 subjects in each of the following age groups: 0-12 months (group 1), 12-36 months (group 2), and 3-12 years (group 3). Ultrasound images of the L3-L4 and L4-L5 lumbar space were taken with a SonoSite 180 ultrasound and high frequency linear probe in the lateral recumbent and sitting positions. The angle from the interspinous space to the skin was measured on printed images using a protractor. A p-value of less than or equal to 0.05 was considered significant. Thirty-eight subjects were enrolled in the study. For the final analysis, 36 subjects with data were included. For the lateral recumbent position, there were 13 subjects in group 1, 10 subjects in group 2, and 12 subjects in group 3. For the sitting position, there were 9 subjects in group 1, 10 subjects in group 2, and 12 subjects in group 3. The mean angles in the lateral recumbent and sitting positions were as follows in each group: group 1: 47.8 (+/-8.2) degrees and 51.1 (+/-8.5) degrees, group 2, 58.8 (+/-6.8) degrees and 59.6 (+/-5.5) degrees, group 3: 60.5 (+/-6.6) degrees and 61.9 (+/-4.0) degrees. The results of each group are significantly different in both positions (p-values = 0.00183 and 0.0108 in the lateral recumbent and sitting positions respectively). However, groups 2 and 3 are not significantly different in both positions (p-values = 0.510 and 0.391 in lateral recumbent and sitting positions respectively). The optimal angle for lumbar puncture is statistically different and more acute in infants than older children. Future directions include determining if these angles when given to clinicians result in increased success rates of lumbar punctures.

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